Limited range of motion, little pain - is surgery necessary now?

[maratimer]

Hi everyone.  I am new to this site and looking for opinions on when the time is right to have surgery.  I am a 45 year old woman in good health.   I was told I had FAI & osteoarthritis in both hips just over a year ago, after numerous doctors / MRIs/ xrays.  My complaint being intermittent pain the hip area, degraded range of motion and muscle loss in the right leg.   My doctor, Dr Paul Beaule from Ottawa, Canada suggested that I would need surgery on both hips, and I was given the choice of single, double, hip resurfacing or hip replacement.  Although I do not feel alot of pain during the normal course of the day, I do not take part in any activity that requires any flexibility or core strength as the muscles are weak in that region, and it is difficult for me to participate.  I swim regularly about 4 hours a week, but can no longer do breaststroke because it hurts my knees and backside too much, and the range of motion required is difficult for me.   I think perhaps I have just gotten used to a very limited lifestyle because of the lack of flexibility/balance/range of motion I have had for several years now.  But again, I have to stress day to day there is little pain.  If I do something such as stand for a long time on a hard floor, try to stretch or do yoga, run or jog, I feel pain in my groin and knees.  On long and busy days, I feel pain in the top of my legs.  I have only been taking Advil to date when necessary.   Sitting in a chair with each leg over the outside of the chair is not even possible for me any longer, that is how bad my range of motion is..and of course it hurts to even try.

My doctor mentioned that my primary symptom was the loss of range of motion, not pain.  He said the longer I waited, the pain will eventually increase but that surgery would restore my range of motion almost immediately with surgery, and allow me to pursue a full and active life.

After reading so many posts on this site, I noted that most people were in terrible pain before they had this surgery so I have to wonder if I am jumping the gun on surgery.   I am currently scheduled for bilateral resurfacing of both hips in September and am trying to ensure I am making the decision that is right for me, and ensuring I am prepared both physically and mentally.  I am a strong and independant person and have dealt with major surgeries before with long recovery time so I feel I can handle this.   I guess because I am not in alot of pain, I am left wondering if I should wait on this surgery. 

I look forward to your comments!
Sandra

[maxx6789]

we seem to have a lot similarities, including both being 45 and scheduled for resurfacing in september (although i am only doing one hip at a time)!!

i was recently diagnosed with OA in both hips. it sounds like i have a little more pain than you. my OA has caused me to give up a lot of things that i enjoyed the most ... running, snowboarding, surfing ... i have slowly had to give these up "over time". sitting and sleeping ... no pain. although my walking is affected, i dont have what i would really call pain.

so ... i have been wondering exactly the same thing as you!! for me, i reached my decision because i no longer want to live without being able to do all the things i most like to do; i reached the mental point where i decided it was time to get better rather than continue to get worse (and i do realize that without something major changing with my body, i am only getting worse day after day). i would say i am about 90% okay with my decision ... i certainly dont "want" to have major surgery but i am hopeful that after these operations to be able to get back to some of the activities i most enjoyed.

one of the doctors i saw (yes, i got a 2nd, 3rd, and 4th opinion along the way), said to me ... "you are not ready, come back to see me when you can not walk" ... well, i cant wait that long (and i would not recommend this doctor at all).

cant wait to hear what other people think about this ...

[bluedevilsadvocate]

Sandra -

I've had a similar reaction --- that most (or at least many) who post on this site had/have substantial pain.  I never did have much pain; occasionally my hip would sort of "catch", which was uncomfortable, but no severe or chronic pain.  But over time I realized that I had reached the point that my hip was significantly adversely affecting my life and lifestyle.  I used to play tennis regularly, but I couldn't really play effectively, so I stopped playing.  When I vacationed with my wife and adult children, we did a lot of sightseeing by walking; but I reached the point that I felt I could no longer keep up and would just slow the others down, so I stopped our usual sightseeing vacations.  Oh, I could walk, but my stride was limited so I couldn't walk at the same pace as others.

I decided that it was time to get on with my life.  I had left hip resurfacing surgery last fall.  Now we're planning a family sightseeing vacation this coming fall.  (I could go now without a problem, but finding a time when all of us can go has put it off to the coming fall.)  My surgeon recommends no impact sports until 12 months postsurgery, so no tennis for now; but I plan to get back to the game this fall.

I have heard that the "wait until you can't stand the pain any more" approach is "old school", and is more common in the U.S. than elsewhere.  To some extent, I think that it is a holdover from years ago when hip surgery --- especially the longevity --- was more uncertain than it is these days.  Frankly, I don't buy into the notion that you should basically put your life on hold and only seek relief when you can't stand it any longer.  That seems detrimental to your mental and physical health.

I'm very pleased with my decision to get moving again.

But the decision is a personal one, based upon individual circumstances and goals.  Nobody should try to pressure or convince you one way or the other.  You know yourself better than anybody else.

Best wishes.

[ScubaDuck]

Sandra-

I am a bit older (50 next month) but otherwise very similar.  I have had severe pain at times but also long periods of no pain.  Once I was diagnosed with OA (left hip only) I realized that I have had limitations starting a long time ago.  In fact I suspect the initial injury was probably in high school.

The pain and reduced range of motion came after a car wreck.  The doctor told me I needed to stop running.  That is when I stopped being active and the hip started downhill.  I was limping pretty badly and would be in bad pain after long walks.

Then I started to try to fix myself.  Massage, stretching, strengthening, losing some weight, etc.  The hip started to feel a bit better.  The good days were better but the bad days were just as bad.  I finally decided to have my doctor x-ray the hip that resulted in the diagnosis. 

Of course I had the usual referral to an Orthopedic surgeon who told me to put up with the pain for as long as I could and then come see him for a THR.  Needless to say I was very depressed because I had already given up some activities I loved to do and the others were becoming more difficult to do and enjoy.

I don't think I am as far along as some of those on this site before they had their surgeries.  I can still tie my shoe and barely clip my toenails on the left foot.  And two weeks ago I did the Grouse Grind, a 2800 foot climb in 1.8 miles, in 54 minutes with little pain.  But I am losing ROM and strength and it is not going to get better.

I think because I still have strength and some decent ROM that my recovery will be quicker.  Sure I question the major surgery when I can still function.  But I feel like I am losing quality of life and will eventually need it fixed anyway.

Good luck with your decision.  I will be a hippy on August 1st.

Dan

[Lopsided]

I had relatively little pain before surgery, and my range of movement was very limited. During the operation, the surgeon found a cyst that had to be filled with a bone graft. If I had waited much longer, I might not have been able to get the uncemented device I requested.

After the operation, I was delighted with my improved range of movement, and a return to normal activities again.

In hind sight, I should have had the operation a couple of years earlier.

It is not about pain, Sandra, resurfacing returns you your dignity.

D.

[hernanu]

Hi Sandra, welcome to the site.

There are many stories here about how we reached the decision to get the procedures. You've probably browsed some of them, there's many more. The common thread in them is that all were progressive, we all began with some loss of flexibility, a decreasing quality of life and the winnowing away of things that we loved to do because of the degradation of the hip(s).

Many posters, including me, wished we had made the decision earlier, before the excruciating pain came, so that the interruption in my life's activities and the impact on my body would have been less. I am deep into my recovery now, and can tell you that nothing I've done for myself has been better. I guess I see no reason to suffer further with a condition that is not going to get better, and will get considerably worse when the alternative has been so positive for many people.

There is also a down side to waiting, since the bone issues can worsen to the point that resurfacing is no longer an option. My brother in law just had surgery, his OA had gotten to the point where he could no longer walk for stretches due to constant dislocations. He put it off, so resurfacing was no longer possible, so he got a mini hip instead - still a good alternative, but it is a choice for people with further damage.

It is your decision, we all came to it at different times. Good luck, and welcome again.

[newdog]

It is not about pain, Sandra, resurfacing returns you your dignity.

That's what I keep telling people. Yeah, I had pain but I COULDN'T DO ANYTHING. They seem to think I had my hips worked on just because I was stiff and sore all the time. One person remarked, "Did you try aspirin or something?"   

Good quote, lopsided.

Sandra, keep us posted.

[larry2458]

i wasnt in that much pain either, but my range of movement was terrible.my good hip suffered as a consequence and i couldnt get my leg over my motor bike any more.all sorted now though and after 2 1/2 the clonking has stopped

[powderhippy]

When you feel life is passing you by, you'll know its time. When its time, make sure you get the right doctor. My first bad pain started when I was 48. I went the route of hip scopes, massage, etc. Finally had my 1st resurface at 53. Damn, missed out on some great skiing, backpacking adventures and walking pain free for that 5 yr period of time. But I was great at taking friends to trailheads and picking them up...!  LOL.
Now one hip will be 5 years old and my other is just one year. Have friends visiting me this week (I live in SW Colorado) and we'll be hiking EVERYDAY. But as the poster before said, don't be pressured. You'll know your time (unless your femoral head wear tells you otherwise).
One last note. When I was going for my 2nd hip last year, there were other patients getting ready for their first one. They were very apprehensive about their upcoming surgery. I told them about and showed them the ROM of my first one. Many had seen my skiing video. A year later I've spoken to a few of them. They can't believe how they've got their quality of life back and are able to hike and bike with their kids. They were scared (understandably) and I think that is what is happening to those who have never had this "major" surgery. When you make that decision, find your doctor, release the stress and know that your plans in the future will not have to be made by how bad your hip will feel....What a great thing Hip Resurfacing is.
Wishing you peace in the decision you make.  Shelly

[susandarn]

Trying to make a similar decision right now. I had my right hip done this past Feb. 2011 having little pain but very severe limp and unable to tie my shoe for almost 2 years. I also could not lie down with my right leg straightened. 6 months after surgery I feel like I can do anything except that now I do have some pain in my left hip. Am working a job where I am on my feet for 12 hours at a shot and doing some lifting (maybe 30 lbs?) I ache every night now in my left hip and my insurance has an out of pocket cap for the year so am trying to decide whether to try and have Dr. Gross fit me in at the end of the year. I am 50 years old and my husband is highly encouraging me to go ahead with the surgery as I have improved so drastically with the last. But aside from aching, I move fine now so am unsure myself what to do. I would love to get off of the multiple doses of ibuprofen every day.

[ScubaDuck]

In my non-medical opinion you have avoided the pain by letting the muscles atrophy.  So your very poor range of motion is a result of those shortened muscles.  It doesn't change what is going on with the hip joint.

Personally I chose to endure the pain to keep a better range of motion.  Of course, I did lose ROM anyway but not as much.  And I did have a limp, some days worse than others.  I think that my recovery from surgery is going better because I still have decent ROM.

I think based on the very limited information you posted that I would side with your husband.  Not only for the maximum out-of-pocket expense but the sooner you will have a better quality of life.  You can reverse the ROM limitations before they get worse.

Best wishes on your decision.

Dan

[Tin Soldier]

Susan - I'm pretty similar.  The pain in the un-operated is not that bad and I still walk very fast, but with a slight limp and some decent pain in the leg.  The pain is not what did it for me, it was the limited ROM and the pain too, but mostly limited ROM.  That is exaclty how my un-opereated hip is, bad ROM, and some pain.  I also have a deducible for the year that has been met.  So why should I wait another year or two and then go through all of this again and pay another deductible?  Actually with the way my insurance provider is headed, they may not be paying for HR in 2 years.  All of that is why I'm going in for number 2 next week.  Good luck with your decision.

[Woodstock Hippy]

I don't think that most of the people here were in ''terrible pain'' before their surgeries.  Most like you and also me have avoided doing the things that cause the pain.  You avoid breaststroke, eventually you won't be able to kick at all when you swim and you'll need a pull bouy.  That's what I've been doing for the past two years, also stopped running.  I took up mountain bike racing in place of triathlon but now I can't get up hill on biclycle.  Work was killing me and I retired on Sept 9 and had shoulder surgery on Sept 13. In the first few weeks after the shoulder surgery I wasn't doing much and I was completely comfortable.  Like you, I was wondering if I really need to do anything about my hips.  As soon as I started to get active again, the pains, lack of balance and lack of strength came back and reminded me why I'm having Bilaterals on 11/15.  Eventually, you will decide it's time for you, and that's when you do it.

And we will be here to suport you!

[maratimer]

Thanks everyone for your opinions, advice and support.  I ended up cancelling my surgery in Sept 2011 thinking that I would wait until it "was time"....Fast forward 1.5 years and I have stopped swimming, find it difficult (painful) to bike, and working out at the gym is basic stretching and cardio only now.  I think I finally realized that this has taken over my life and I am working with "what I can do" not "what I would like to do"...

After reading everyone's comments, the decision is clear to me.  Its time, and I'm ready.  Waiting on confirmation of surgery date but expecting June 2012 with Dr. Paul Beaule in Ottawa.  I'll keep you posted. 

[hernanu]

Thanks everyone for your opinions, advice and support.  I ended up cancelling my surgery in Sept 2011 thinking that I would wait until it "was time"....Fast forward 1.5 years and I have stopped swimming, find it difficult (painful) to bike, and working out at the gym is basic stretching and cardio only now.  I think I finally realized that this has taken over my life and I am working with "what I can do" not "what I would like to do"...

After reading everyone's comments, the decision is clear to me.  Its time, and I'm ready.  Waiting on confirmation of surgery date but expecting June 2012 with Dr. Paul Beaule in Ottawa.  I'll keep you posted.

The right time is when you feel it is, as long as an HR is still possible. Good decision, now you can go forward.